| NPI | 1699088757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: ME ME14003) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: ME MC12576) |
| Enumeration Date | 2010-07-19 |
| Last Update Date | 2022-11-04 |